Chronic Pelvic Pain in Endometriosis: An Overview

Abstract

Chronic pelvic pain (CPP) could be considered nowadays a deep health problem that challenges physicians all over the world. This because its aetiology is still unclear, the course of the disease could vary a lot among different patients and through time in the same patient, and the response to treatments is not every time successful. Among women who underwent laparoscopy for CPP, endometriosis is found in about 1/3 of the cases, while only 25% of women with histological confirmed endometriosis are asymptomatic. A wide range of variables may exert their influence on the resulting pain syndrome in endometriosis; for example, score according to American society for reproductive medicine (rASRM), size of the sub-peritoneal and pelvic wall implants, Douglas obliteration, previous surgery. It is widely accepted nowadays that central nervous system (CNS) and peripheral nervous system (PNS) seems to influence each other and this interconnection play a key role in pain modulation. Moreover, the phenomena induced by endometriosis in the pelvis, including the breakdown of peritoneal homeostasis and the induction of the production of proinflammatory and proangiogenic cytokines, are responsible of altered innervations and modulation of pain pathways in these patients. There are many proposed medical and surgical approach to treat this painful syndrome, although there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis of the causes of endometriotic-related CPP, and therefore facilitate its eradication.

Is M235T polymorphism of the angiotensinogen gene involved in the development of endometriosis?

“…Some of them complain of very severe pain (painful menstrual periods, PMS, pelvic pain, dyspareunia), often cyclical, which is associated with changes in sex hormone levels during the menstrual cycle. Other patients, despite significant severity of the lesions experience no pain [1]. The pain associated with endometriosis on the one hand results from the innervation of endometriotic deposits, on the other hand lesion-induced inflammatory process of nerve fibers is of significance.…”

“…It appears that in the immediate vicinity and inside the endometrial implants new nerve fibers are formed, accompanied by immature blood vessels [25]. The nerve growth factor (NGF) and vascular endothelial growth factor (VEGF), the levels of which are increased in the eutopic and ectopic endometrium of women with endometriosis, are involved in both neurogenesis and angiogenesis processes [1,6,25]. The above data suggest a possible involvement of the neovascularization process in the perception of pain by women with endometriosis, that is why the authors of this study decided to check whether there is a correlation between the M235T polymorphism of the AGT gene and pain.…”

“…It affects about 10% of women in their reproductive years [1,2]. Clinically it is often manifested by chronic pain (menstrual, perimenstrual, dyspareunia, pelvic pain) and fertility problems.…”

“…The amount of pain a woman experiences is not necessarily related to the severity of the disease. Some women with severe endometriosis may experience no pain, while others with a milder form of the disease may have severe pain [1].…”

Captação de nanopartícula lipídica marcada radioativamente por receptores de LDL em membrana celular de focos de endometriose

“…Sabe-se que acomete cerca de 10% das mulheres em idade reprodutiva e pode promover sintomatologia álgica muitas vezes incapacitante, assim como ser causa de infertilidade feminina, havendo, por vezes, indicação de tratamento cirúrgico como principal estratégia terapêutica (Redwine et al, 1992;Triolo et al, 2013;Cao et al, 2015;Darwish & Roman, 2016;Lagana et al, 2016). Estimam-se que 5,3 a 12% das mulheres com endometriose apresentam a forma mais severa da doença com comprometimento profundo do intestino, o que pode tornar o tratamento cirúrgico complexo, levando a eventual persistência dos focos, além das possibilidades de recorrência das lesões (Konickx et al, 1991;De Cicco et al, 2010;Kondo et al, 2011;Nezhat et al, 2011;Abrao et al, 2015;Magrina et al, 2015;Rausei et al, 2015;Lagana et al, 2016) e alteração na qualidade de vida (Bassi et al, 2011;Mabrouk et al, 2011;Simoens et al, 2012;Ribeiro et al, 2014;Selvi Dogan et al, 2016;Giussy et al, 2017).…”